How common is premature menopause in cancer therapy?
That’s tough to answer globally. The published rates among pre-menopausal women are from 40% to 90%, so it’s highly variable. As a gynecologic oncologist, I see it in many of my patients. It's hugely impactful on people's quality of life.
How does it happen, and how does it impact fertility?
Mostly, we’re talking about premature ovarian insufficiency, an early loss of ovarian function, as a result of cancer treatment.
People say “chemopause” because chemo is often involved, but unfortunately, there are many different ways we can injure the ovaries. If you’re getting chemo, depending on what drugs you're getting; or we're removing ovaries with surgery; or we're giving you radiation in the pelvis – any of those things can injure the ovaries and result in impaired fertility, loss of estrogen and progesterone, and induced menopause.
Are there many types of cancer where treatment can lead to premature menopause?
Treatments that can lead to premature menopause can include many chemotherapies, as well as surgery involving removal of the ovaries, and radiation in the pelvis. These therapies are used for a variety of cancer types, including gynecologic cancers, colorectal cancer and breast cancer, to name a few.
There are also chemotherapy drugs used for non-cancerous conditions, such as autoimmune conditions, that have these effects as well. And many women with breast cancer and some gynecologic cancers receive endocrine, or anti-estrogen, therapies which incite menopause.
Do women who experience premature menopause have symptoms that resemble naturally occurring menopause?
Yes, it’s typically the classic menopause symptoms: Hot flashes, low energy, poor sleep, and sometimes mood changes. And then we sometimes have more worrisome things that can have health consequences, like bone thinning, increased risk of cardiovascular disease, or dementia.
We have to be cautious in our treatment planning for menopause symptoms in women with cancers. We need to consider the safety of hormone replacement depending on someone's tumor behavior, specifically whether hormone replacement could increase recurrence risk.
Before cancer treatment begins, what are some things a pre-menopausal woman who’s diagnosed with cancer and her provider can do to minimize this kind of impact?
Providers and their patients should talk about the consequences on hormone function of any upcoming treatment, no matter what cancer type it might be, or for non-cancer chemotherapy
If a woman has already begun cancer treatment and is experiencing premature menopause, what are some things that can be done to help her?
When the ovaries are injured by treatment, what we’re looking at is a loss of estrogen and progesterone. That’s what's driving the symptoms. So whenever it’s possible and safe, often we're replacing estrogen and progesterone that's been lost.
But in many cases, especially with gynecologic and breast cancers, women can't get estrogen because their tumor likes estrogen. So then we have to think more creatively about non-estrogen mechanisms to make people feel better.
We have several medications, including some novel therapies that have come out in the past few years, to help manage their symptoms. We also partner with folks from different specialties, like pelvic floor physical therapy, to help with different symptoms.
→ More information on clinical trials and research in gynecologic cancer at the CU Anschutz Cancer Center.
During or after cancer treatment, is fertility loss sometimes reversible?
It depends on what chemotherapy drugs you’re getting. For radiation or for certain chemo drugs, it likely won’t be reversible, so we need to act before treatment begins. With surgery, sometimes there are ways to preserve one ovary, or to preserve eggs. There are different tools in the toolbox, depending on the timing and the situation.
Tell me about your Fertility and Reproductive Late Effects Program.
It began about five years ago, and I became director in late 2025. Our mission is to provide medically informed access to fertility preservation for young people who are having to make decisions about surgery, radiation, or chemo. And we provide optimal care of the late effects of treatment for both males and females who are impacted by cancer care. We offer a unique perspective where I, as an oncologist, our gynecology team, and our breast team all collaborate.
Ideally, we would see patients before they initiate surgery, radiation, or chemo so we can have a conversation about protecting future fertility or future hormone function. But we are happy to see patients when they begin treatment, or once they're on the other side and struggling with menopause symptoms or fertility.
Typically we see patients through referral from their oncology or non-cancer chemo provider, but patients can also reach out to us directly.
In your view, is there enough awareness in the oncology community about these issues, so that when a cancer treatment plan is developed, the risk of premature menopause and fertility issues is fully taken into account?
I think we can do more. It really comes down to provider education. I'm working hard in this new role as the director of this program to get information out there to providers statewide, to let them know that we're here for them and their patients. We can also educate residents and fellows so they’re aware as they begin their careers.
Hopefully in the future we can expand further to neighboring states where this resource doesn’t exist, because much of what we do can be done with remote visits and discussions. I’m excited in this new role about the opportunity to build up this program and make it more accessible.
→ More information about Fertility Preservation Program services and how to contact them.
